Long face/mouth breathing syndrome; contemplating surgery...

[hollowandalone]

I'm 20, male, and suffering from major depression. I've also realized for some time that I have a facial balance/proportion problem because of what orthodontists call vertical, or misdirected, growth, probably resulting from mouth breathing when I was younger and causing facial features usually called "adenoid facies", also known as "long-face syndrome" or "mouth breathing disorder"...That is, a slight overbite, thin upper lip, gummy smile, high & arched palate, slack jaw, slightly receded chin, laterally recessive mandible, disproportionate lower face length (approx 1.5x midface length), and pointed looking jaw. I think I might also have a slightly obstructed nasal airway. I have a history of allergies and nasal infections during early childhood, which fits with the mouth breathing issue. I also used to have some speech difficulties and an abnormal swallowing pattern, although those are mostly gone now. Oddly enough, I never had any problem with crowding or needed any extractions at all

It's not the overbite that bothers me really, I actually find it's hardly noticeable. I did have braces to treat an open bite when I was 11, but that hasn't recurred since and my teeth are generally straight now without any major bite problems. My main features that really bother me now are:
- From the side, my profile looks...large and flat. It's difficult to explain; perhaps the best way of putting it is that it looks as of the mandibular plane has been vertically dragged down compared to where it ought to be, and the whole side of the face has no real "depth" to it, like a square/rectangular plane with a harsh-looking 90 degree angle at the chin. From the side, the lower jaw seems to protrude from lower down the neck than it should, making my neck look short.
- Viewed from the front, my cheeks seem to recede in the lower third of my face (which is noticeably longer than the middle third) because of my narrow lower jaw, which gives the appearance of an elongated U-shape from one cheekbone to the other, with no discernible corners, jawline definition, or width around the lower face. The length from the base of my nose to the tip of my chin is about 1 and a half times the distance from that same point to the side of my face (they should be equal).
- My smile, or rather the narrowness and general unnatural-ness of it.

What are the treatments that would help to minimize or eliminate these issues? I'd like to give my face more fullness and make it look less long and narrow, with the lower third more balanced with the other two. My symptoms are fairly minor compared to some pictures I've seen, but I feel they're fairly noticeable...

Until a few weeks ago I'd been uneasy at the idea of suggesting surgery for purely cosmetic purposes, but finding out that it is in face a recognized deformity for which reconstructive orthognathic surgery is the accepted treatment has made me feel somewhat more confident with the thought...and I suppose it's also a functional improvement if it ends up improving my breathing. I've yet to approach my orthodontist about this, and would prefer to enter into that kind of discussion with him only once I have a little more information on the treatments that exist. At the same time I'm terrified at the thought of undergoing surgery, since I've read quite a few horror stories about the results not being as expected and the slew of horrible side-effects that can occur.

Please believe me when I say I wouldn't even be considering this if I didn't feel it was something that had utterly destroyed my life up until now.

[Muffinmamma]

I can't provide the information you ask for, I think it would be difficult for anyone to do so without seeing you, surgery should be based on very individual needs. For that reason I would suggest that you set the wheels in motion to see a surgeon, if it's on the NHS you will have plenty of time to consider your position while you await an appointment!

I had work done on my top and bottom jaw without ever being asked how I felt about it (or why I wanted it). I gather from other postings that in some areas people have to undergo psychological assessment prior to work starting, as you say you are depressed (and your username is heartbreaking..). This sounds that it could be useful to you, but will add months on to your wait for surgery, if you decide to go that route and is another reason to see someone sooner than later.

As to the pain involved, it hurts of course, but it's not unbearable. The important thing is to know what to expect post op, this website is brilliant for that, if you put your mind to it you'll be able to handle it.

Best wishes to you, you'll find many friends on here to help you through x

[PJ]

First and foremost--I hope that you are addressing your depression with a therapist. That is going to affect you as much, if not more than, your jaw issues. That being said, I agree with Muffinmama that you should consult with someone--whether your OD or an OS about whether the surgery would be right for you, and what all will be involved.

I hear you about being terrified--trust me, every person who ever undergoes any type of surgery is going to feel that way, but orthognathic surgery has been around a long time, and you are more likely to hear the horror stories--because when things go wrong, it's more interesting. Nobody ever writes a novel where everything goes well. I had my surgery a little over 5 weeks ago and I can tell you that I was terrified for no reason. Sure, it will be annoyingly uncomfortable for a time afterwards, but it's nothing you can't get through--and compared to many other issues, it is a walk in the park. Not to mention, that when all is said and done, you will likely have no regrets, and you can get on with the business of finding happiness. I wish you all the best. Feel free to PM me if you have any questions I can answer.

Btw--I had Lefort 1 and BSSO to correct an open bite--I also was a mouth breather, I had sleep apnea, and the long face and gummy smile. They couldn't do anything about the thin lip--I think that would call for plastic surgery, but I am not that interested in fixing it.

[Saffie]

As other people have already suggested, you should ask for a referral as soon as possible because you'll be waiting for anything between a couple of months and a couple of years. Depending on where you live, your depression could be seen as a reason to have the surgery, or a reason not to, or they might not care either way.

It can be incredibly frustrating. I'm waiting for a psychological assessment at the moment, and the surgeon is in two minds about whether to treat me because I was once almost diagnosed with body dysmorphic disorder because I was convinced there was something wrong with my face - never mind that I was actually right - and he thinks that having a "history" increases the chances of me having a nervous breakdown when he changes it. But at the same time, he only operates on people who will derive a "psychological benefit" from it, which means there has to have been a problem before surgery. However, I've had some reassurance from the orthodontist that even if the surgeon decides not to do it now, it doesn't mean that I can't have the surgery ever, as I could always be considered again at some point in the future.

[hollowandalone]

Thanks for the support and info, I really appreciate it.

The depression is an issue, I know...it's actually even more complicated than that, but I don't really have time to discuss that now...I'll explain some other time... I think that if the surgery worked, it would be a much bigger help in getting over it than any medication would ever be.

I looked up the procedures you mentioned as well as a few other common ones, and it reminded me of another thing that bothers me about my current appearance, which is the angle of my lower jawline...namely that at the back near the corner, the two sides are almost parallel and the whole thing looks extremely narrow, to the point where the corners are actually not visible from the front because they're hidden by my cheeks (which in turn are very narrow...so that should give you an idea of the problem ). It doesn't sound like Lefort 1 or a BSSO would change this very much...but then again I don't know very much about surgery. What sort of procedure would I be looking at the fix this problem? I did read something about an MSDO, but that only seems to be used to solve crowding issues, which I've never had (even with my wisdom teeth...yeah weird I know).

[PJ]

I think your best bet is to consult with a surgeon about the exact procedure/s you might need. I don't know much about this stuff except for what I had--which was basically moving both the upper and lower jaws forward.

[TinaAH]

I didn't know there was a term for this. This is what I had and why I had the procedure done. Basically, I have a mild type of Muscular Dystrophy - which means my facial muscles are weak and I have always breathed "slack jawed" with my mouth open.

My palate was so high that when they did the mouth impressions (a metal mouth formation filled with goopy plaster of paris type yuckiness), they had to do them twice because the tech didn't put enough of the plaster in the first time...and it didn't fill in my palate all the way. How embarrassing that was when they all thought it was kind of funny. I also hated the way my face looked because it was so long. It actually did the opposite to my nose, than yours...my nose was long and pointy, which looked <sarcasm> GREAT </sarcasm) with a ridiculously long face. I was so self-conscious that I got angry whenever someone tried to take my picture.

Anyway, I am about 7 weeks post-op and I'm really happy with the results. I feel like my face looks a lot closer to being normal than ever. Of course, I'd probably never be 100% happy unless I looked like a super-model (haha) - but I actually feel okay about getting my picture taken now. I'm still slightly swollen, but someone actually called me "pretty" today and I almost cried. I'm definitely not going to ever win any beauty contests, but feeling like I'm not a freak makes me actually feel like I want to be socially involved now.

I would suggest that you get some counseling for your depression and self-image issues, but also seriously consider having lefort surgery. It wasn't nearly as bad as I thought it would be, but I prepared myself for the absolute worst. I haven't regretted it for a second.

Good luck.

--Tina

[TinaAH]

I didn't know there was a term for this. This is what I had and why I had the procedure done. Basically, I have a mild type of Muscular Dystrophy - which means my facial muscles are weak and I have always breathed "slack jawed" with my mouth open.

My palate was so high that when they did the mouth impressions (a metal mouth formation filled with goopy plaster of paris type yuckiness), they had to do them twice because the tech didn't put enough of the plaster in the first time...and it didn't fill in my palate all the way. How embarrassing that was when they all thought it was kind of funny. I also hated the way my face looked because it was so long. It actually did the opposite to my nose, than yours...my nose was long and pointy, which looked <sarcasm> GREAT </sarcasm) with a ridiculously long face. I was so self-conscious that I got angry whenever someone tried to take my picture.

Anyway, I am about 7 weeks post-op and I'm really happy with the results. I feel like my face looks a lot closer to being normal than ever. Of course, I'd probably never be 100% happy unless I looked like a super-model (haha) - but I actually feel okay about getting my picture taken now. I'm still slightly swollen, but someone actually called me "pretty" today and I almost cried. I'm definitely not going to ever win any beauty contests, but feeling like I'm not a freak makes me actually feel like I want to be socially involved now.

I would suggest that you get some counseling for your depression and self-image issues, but also seriously consider having lefort surgery. It wasn't nearly as bad as I thought it would be, but I prepared myself for the absolute worst. I haven't regretted it for a second.

Good luck.

--Tina

[dentalguy]

I really feel for you and your current state of unhappiness. I too have had problems with mouth breathing and still do it at night - whether it's sinus trouble or something else, one of my nostrils (it alternates) seems to be blocked. I wonder too if I've got an arched palate and if this has restricted the size of my nasal airway.

I too was slack jawed - if by that you mean didn't keep my mouth closed when I was young - and did a lot of mouth breathing. However, these foibles, coinciding with an early growth spurt and a poor swallow, seem to have given me an excessive mandible by contrast. It seems I went from pre-adolescence, where I had a fairly normal bite, to one by the end of my teens where my front teeth sit on top of each other with my upper incissors being splayed forwards to attain this edge to edge bite. I now have a much more prominant chin and a less than appealing smile where my lower lip comes right up over my teeth.

I just wish, and I'm sure you and others would agree, that there was more information out there so that parents could do something about their kids bad habits/breathing problems, etc. before facial growth is affected. I've read that proper breathing, swallowing and even things like singing can do wonders for correct growth in the lower face.

But I really hope you can find a way through all this get the treatment (and outcome) you desire.

Ps. if you don't mind me asking, what sort of speech problem did you have and do you know how/if it was connected to your facial growth/oral problems? If that's being a bit forward, just tell me to mind my own business.

[AF104]

When some people find out that they have a particular cosmetic anomaly they ascribe all of their psychological problems to it. It's unlikely that surgery is going to make you happy. If your expectations are too high no outcome will be good enough for you. I found my experience with orthognathic surgery great but I had it done for functional reasons and accepted whatever cosmetic improvement came with it. Jaw surgery will certainly improve your airway. I think what you meant by "nasal" infections is "sinus" infections because isolated nasal infections are rare. Shortening the maxilla could make that problem worse since the dimensions of the maxillary sinuses would also be decreased. That could warrant future sinus surgery. Anyway if a surgeon feels that you have enough of a deformity to warrant surgery then go for it. If you expect it to cure your depression or change who you are you're going to be even more depressed later though. Good luck.

[Polly]

Like others have said it is hard to say what surgery would be best for you. Ask your orthodontist what they think about referring you to a surgeon. The surgeon will then go through all the options with you and he will advise you on the outcome of any surgery etc. It is 2 years today since I had my first jaw surgery, I needed it due to problems concerning Marfan Syndrome. I don't regret a single second of orthodontic work or surgery. Don't keep wondering, take the first step by consulting your orthodontist and see what they say

Good luck

Polly x

[fromjersey]

hollowandalone: You may not see it right now, but finding out that something can be done could be a reason to rejoice. Think of how your depression can end. I am anything but a Pollyanna person. On the contrary. I do understand the depression and for me I had no understanding of what could be done medically to change it. These days we have so much more information out there.

Please try to move ahead, get more information on what procedures are available and let it give you hope. I'm not only speaking from experience but from my unusual age when I finally got something done. I was almost age 80. And the more you read what people say on this site the more you see a lot of similarity with mouthbreathing, nasal obstruction, allergies and recession of mandible. Be glad you found this site and plan on moving forward and being happier and healthier. Good luck to you and find a good surgeon. Important part of all of this.
Helen

[kahootz]

And, when you do get an opinion from a surgeon - get another opinion to make sure he/she is right! I had lower jaw surgery to correct my overbite, only to find out later I should have had upper and lower jaw surgery! I still have a bit of lip competence, a high palate and a little bit of a long (more narrow) face. I put total trust in a surgeon who actually is highly regarded in putting peoples faces back together in the ER (plus my orthodontist highly recommended him). Now I'm stuck trying to make it all come together, but don't know if I would go through another surgery to correct it - plus I'm a month away from having my braces removed.

One thing I can say is that thinking about all this and studying your face for what you don't like, can really make you self conscious. I used to think of myself as fairly attractive, but have been driving myself crazy lately by looking at what could have been.

Definitely get an opinion from a couple surgeons and you will probably feel hopeful that there is a solution to your problem.

[loftry]

Hi,

I am a 17 year old male who is a similar case to you: mouth breathing all my life, now has lip incompetence, long narrow face (more specifically thin and long jaw), thin and short upper lip, etc and i also had crowding which had to be corrected with braces aged 15-16. Like you am also depressed about my face as i feel i have an other wise fairly good looking face, but my lower face ruins this.

So I was wondering if you have had this problem fixed for you, and if yes what exactly you did about it and whether or not you are happy with the results?

I would really appreciate any help!

Thanks

[kahootz]

Wow, I haven't been on these boards in ages - but am happy to reply. No, I never did get this all fixed. No other surgeon would touch me after having the first surgery. There is just too much risk for further nerve damage, plus I think they (the surgeons) are afraid to fix someone elses work. I even went to Dr. Gunson in Santa Barbara. He gave me a nice picture of what could have been and then pretty much said he wouldn't touch me.

If you are only 17 and still in braces, hasn't your orthodontist recommended that you have jaw surgery? If not, I would definitely schedule an appointment with a few oral surgeons versed in this type of surgery. If you can do it, and it is a surgeon's recommendation that you do, I would go for it.